Provider Demographics
NPI:1023744596
Name:THOMPSON, SAMANTHA
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 STEWART AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-2135
Mailing Address - Country:US
Mailing Address - Phone:330-787-2840
Mailing Address - Fax:
Practice Address - Street 1:1404 SUNNY DR
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1450
Practice Address - Country:US
Practice Address - Phone:866-912-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide